
<include file="Public:head"/>

<div class="pleft">
			<label><b class="b"></b><strong>申请区域加盟</strong></label>
	

			<h4 style="clear: both; font-size: 15px;">请认真填写下面信息，提交后有专人与您联系</h4>

			<form>
				<table>
					<tbody><tr>
						<td class="fst">*</td>
						<td class="snd">意向加盟的城市：</td>
						<td class="thd"><input class="must"></td>
					</tr>

					<tr>
						<td class="fst">*</td>
						<td class="snd">公司名称：</td>
						<td class="thd"><input class="must"></td>
					</tr>

					<tr>
						<td class="fst">*</td>
						<td class="snd">公司联系人：</td>
						<td class="thd"><input class="must"></td>
					</tr>

					<tr>
						<td class="fst">*</td>
						<td class="snd">公司联系人QQ：</td>
						<td class="thd"><input class="must"></td>
					</tr>

					<tr>
						<td class="fst">*</td>
						<td class="snd">公司联系人电话：</td>
						<td class="thd"><input class="must"></td>
					</tr>


					<tr>
						<td class="fst">*</td>
						<td class="snd">公司详细地址：</td>
						<td class="thd"><input class="must"></td>
					</tr>

					<tr>
						<td class="fst">*</td>
						<td class="snd">公司主营业务：</td>
						<td class="thd"><input class="must"></td>
					</tr>

					<tr>
						<td class="fst"></td>
						<td class="snd" valign="top" style="padding-top: 5px;">加盟主要优势：</td>
						<td class="thd"><textarea></textarea></td>
					</tr>

					<tr>
						<td class="fst"></td>
						<td class="snd"></td>
						<td class="thd"><input class="sbm" type="button" value="立即申请"></td>
					</tr>
				</tbody></table>

                <input type="hidden" id="_token" value="9ab12ee3-a6b8-4ffc-91de-06f9a2c38ecc">
			</form>
		</div>



		<div><img src="__IMG__/bi/jr.png" alt=""></div>




		
  <include file="Public:foot"/>